MEDICARE: MS. ELIZABETH STOLTENBERG MS, MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.101944	IL
2	1041C0700X	Clinical Social Worker	149.020133	IL

General Provider Information

NPI Number	:	1861949729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH STOLTENBERG MS, MSW, LCSW

Provider Business Mailing Address
First Line	:	5215 N RAVENSWOOD AVE STE 214
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	773-888-2158
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N RAVENSWOOD AVE STE 214
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1670
Country	:	US
Telephone Number	:	773-888-2158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	08/05/2022

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